Sialendoscopy can be followed by swelling and infection of the salivary gland. A possible pathomechanism is damage of the deeper salivary duct system by intraductal pressure generated by the irrigation fluid.

After measuring the physiological intraductal pressures which arise during sialendoscopy, these pressures were simulated in freshly excised salivary glands and the tissue was analysed histologically.

Normal intraductal filling pressure during sialendoscopy is 100–250 daPa, and pressure peaks can be up to 2000 daPa during flushing. A filling pressure of more than 400 daPa results in dilatation of the salivary ducts and acinar area. No direct damage to any duct structures could be observed histologically.

Irrigation fluid should be administered intermittently rather than continuously during sialendoscopy. The intraductal filling pressure should not exceed 400 daPa to minimise the trauma to the salivary duct system and reduce the risk of developing oedema and inflammation.

Eosinophilic angiocentric fibrosis is a rare benign disorder of the upper respiratory tract. It is slow growing and progressive, with characteristic histological appearances.

We report the largest single-institution case series of sinonasal eosinophilic angiocentric fibrosis to date, comprising nine patients. The current literature is reviewed, showing emerging evidence that this condition may belong to the immunoglobulin G4-related disease spectrum.

The series comprised five female and four male patients, with a mean age at presentation of 53 years. All were treated surgically. Six patients had no signs of recurrent disease after an average of 8.5 years. One patient went on to develop granulomatosis with polyangiitis (Wegener's granulomatosis), which required immunosuppressive therapy.

The first-line management of this rare condition is complete surgical excision. Chronic granulomatous conditions, including granulomatosis with polyangiitis, should be excluded before a diagnosis is made, and patients should be carefully followed.

We report the first use in Australia of hyperbaric oxygen therapy for sudden hearing loss following head trauma in a child with large vestibular aqueduct syndrome.

A 12-year-old boy with large vestibular aqueduct syndrome presented with significant hearing loss following head trauma. He was treated with steroids and hyperbaric oxygen therapy, with good improvement of hearing thresholds on audiography. This case represents the first reported use of hyperbaric oxygen therapy for this indication in Australia, following a few previous reports of patients in Japan. We review the literature on management of acute sensorineural hearing loss in large vestibular aqueduct syndrome. The reported case demonstrates a potentially beneficial therapy for a rare condition that usually results in an inevitable decline in hearing.

Hyperbaric oxygen therapy can be tolerated well by children, and may represent a potential treatment for sudden sensorineural hearing loss in patients with large vestibular aqueduct syndrome.

To estimate the incidence of tympanogenic labyrinthitis ossificans.

The records of patients treated with mastoidectomy for various tympanogenic aetiologies from January 2007 to December 2011 were retrospectively reviewed. Patients whose high-resolution computed tomography scans showed evidence of labyrinthine calcification of the temporal bone were enrolled. Patients with a history of head and neck cancer, meningitis, and otosclerosis, and patients with cochlear implants, were excluded from this study.

A total of 195 patients were enrolled in this study; 4 of the patients presented with calcification in the inner ear. Therefore, the incidence of tympanogenic labyrinthitis ossification was 2 per cent. The computed tomography findings revealed: (1) cochlear calcifications of the basal and middle turn in two patients; and (2) vestibular, superior semicircular canal, posterior semicircular canal and lateral semicircular canal calcification in one, four, three and two patients, respectively.

The incidence of tympanogenic labyrinthitis ossification in patients who had undergone a mastoidectomy was 2 per cent.

We aimed to identify the role of major respiratory viruses in the aetiology of human nasal polyps using polymerase chain reaction technique.

Thirty patients with nasal polyps and a group of 20 healthy patients (control group) were included in this study. Mucosa was obtained from the polyps of patients with nasal polyposis and from the middle turbinate of the control group patients by means of biopsy. The samples were stored at −80 °C until molecular analysis by polymerase chain reaction was carried out.

In the control group, the human coronavirus and human rhinovirus were diagnosed in one of the patients and the human respiratory syncytial virus in another. In the group with nasal polyposis, the influenza B virus was identified in one of the patients and the human coronavirus in another.

The results did not demonstrate a statistically significant relationship between nasal polyposis and respiratory viruses.

Sinonasal malignancies are rare tumours, which can be resected using an open or endoscopic approach. The current study evaluated the outcome of both approaches.

A total of 160 patients with malignant nasal tumours were evaluated in an academic tertiary care hospital. The patients were allocated to ‘open’ or ‘endoscopic’ surgery groups, based on the surgical approach employed. The following data were evaluated and compared: patient and tumour characteristics; oncological treatments; and oncological outcomes, including complications, surgical margin, recurrence, overall survival and disease-free survival.

The maxillary sinus was the most common tumour location and squamous cell carcinoma was the most common histopathology-based diagnosis. Younger patients had lower grades of tumour. Higher survival rates were significantly related to lower tumour stages in both surgery groups. There were no differences between the two relatively similar groups in terms of surgical margin, the need for adjunctive therapy, and recurrence and survival rates. In addition, multivariate logistical regression analysis indicated no correlations between the type of surgical approach employed and the rates of recurrence and complications.

Endoscopic surgery for sinonasal malignancies is comparable to the conventional open approach in carefully selected patients.

This study aimed to determine whether or not the middle cranial fossa dural plate is located lower (i.e. more caudally) in patients with chronic otitis media, relative to adjacent structures.

The authors retrospectively investigated computed tomography temporal bone scans of 267 ears of 206 patients who had undergone surgery with a diagnosis of chronic otitis media, together with scans of 222 ears of 111 patients without chronic otitis media. The depth of the middle cranial fossa dural plates was recorded.

The mean depth of the middle cranial fossa dural plate was 4.59 mm in the study group and 2.71 mm in the control group (p < 0.001). The middle cranial fossa dural plate was located lower in the right ear in both the study and control groups.

The middle cranial fossa dural plate was located lower in patients with chronic otitis media, and in the right ears of both patients and controls. Surgeons should take this low location into consideration, and take extra care, during relevant surgery on patients with chronic otitis media.

To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay.

This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements.

No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months.

Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.

Recurrent aphthous stomatitis is a common disease of the oral mucosa, affecting 20 per cent of the general population.1 However, the aetiology of this disease is unknown. This is the first controlled study to compare zinc levels in recurrent aphthous stomatitis patients with those of a well-matched, healthy, control population.

Twenty-five patients with a history of recurrent aphthous stomatitis and 25 healthy people (control group) took part in the study. Patients aged between 20 and 40 years with recurrent oral aphthous ulcers less than 1 cm in diameter were included. Exclusion criteria were pregnancy and lactation, systemic disease (ulcerative colitis, Crohn's disease, Behçet's disease), any current medication (topical or systemic), dental surgery during the previous month and deficiencies in iron, folic acid or vitamin B1, B2, B6 or B12. Serum zinc levels were compared between patient and control groups.

Zinc deficiency was detected in 28 per cent of recurrent aphthous stomatitis patients and in 4 per cent of controls. The mean serum zinc level in the patient group was significantly lower than in the control group.

These results suggest an association between zinc deficiency and recurrent aphthous stomatitis.

Epidermal growth factor receptor (EGFR) overexpression and prognostic value in head and neck squamous cell cancer is the basis for targeting by anti-EGFR antibodies, which increase the efficacy of radiotherapy. In order to evaluate the best therapeutic schedule, the effects of cetuximab (C225) on Hep-2 cell proliferation, alone and in combination with cisplatin, were studied.

Hep-2 cells were treated with cetuximab alone or in combination with cisplatin. After determining cell viability with trypan blue, morphological features of apoptotic degeneration were analysed by fluorescence microscopy with Hoechst 33258 stain.

Cetuximab alone mildly inhibited Hep-2 proliferation and showed no pro-apoptotic effects. When administered concomitantly with cisplatin, cetuximab synergistically increased inhibition of proliferation and apoptosis.

The antiproliferative activity of cetuximab is consistent with its hypothesised role in inhibiting repopulation. However, the increase in the effects of pro-apoptotic agents induced by cetuximab may be even more relevant to its clinical effectiveness than the inhibition of repopulation.

To quantify the impact that mild to moderate tonsillitis has on quality of life in children and compare it to that of severe tonsillitis.

In this prospective study, parents of children aged 0–16 years completed the Paediatric Throat Disorders Outcome Test, and quality of life scores in the tonsillitis groups were compared.

A hundred children were recruited: 58 had severe tonsillitis and were offered surgery, and 42 had mild to moderate tonsillitis and were managed conservatively. The mean outcome test scores in those children undergoing surgery were 36.7 for tonsillectomy patients and 36.9 for adenotonsillectomy patients, compared with a score of 31.5 for the mild to moderate tonsillitis patients (p = 0.019).

Children with mild to moderate disease had significantly better quality of life scores than those with severe disease. It is thought that those with mild to moderate disease have short-term improvements in general quality of life after surgery, which disappear in the medium term. This transient improvement needs to be balanced against the morbidity of the surgery and the cost burden to the National Health Service. The results of this study support the national drive towards limiting tonsillectomy to children with severe tonsillitis or obstructive sleep apnoea.

To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions.

Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted.

A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively.

Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.

Cochlear implants have enabled an improved quality of life for many patients with deafness. Implant extrusion and skin flap necrosis are the most common complications associated with implant use. We report our management of patients presenting with complications as a result of cochlear implant insertion. The goal of surgery was to achieve a stable, healed wound for use as a cochlear device implantation site.

We describe a series of patients presenting with skin flap necrosis and/or extrusion of their cochlear implant. The reconstructive options employed are discussed.

Surgeons should be aware of the reconstructive options available in such circumstances, and should choose appropriate management depending on the clinical situation, in order to optimise the functional result for the patient.

We aimed to evaluate the relationship between swimming pool pollutants and allergic rhinitis in swimming pool workers.

Twenty-seven indoor pool workers (group 1) and 49 control subjects (group 2) were enrolled in the study. A skin prick test was performed and a nasal smear was obtained from each subject to evaluate rhinitis.

When the groups were compared in terms of epithelial cells, group 1 had significantly more epithelial cells than group 2. When the groups were compared with regard to eosinophils, group 1 had significantly more eosinophils than group 2. The skin prick test results for both groups were not significantly different.

Indoor pool workers showed severe symptoms of rhinitis and eosinophilic nasal cytology, likely due to chlorine. Nasal cytology is an easy-to-administer diagnostic test and can be used to follow up rhinitis in indoor pool workers, along with nasal endoscopy, a detailed clinical history and a skin prick test.

Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre.

A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed.

Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations.

High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

Cerumen impaction is a common problem, and aural microsuction is a technique frequently employed for its management. This study aimed to quantify the patient perception, safety and efficacy of this procedure.

Patients were asked to complete a questionnaire following cerumen clearance by microsuction. The perceived severity of pain, noise-related discomfort and vertigo was scored on a scale of 1 to 10. Patients with mastoid cavities and those who had used a cerumenolytic agent in the preceding week were analysed separately.

A total of 159 questionnaires were returned. Mean scores (95 per cent confidence intervals) were: pain, 2.34 (2.06–2.62); noise discomfort, 3.03 (2.71–3.35); and vertigo, 1.95 (1.66–2.25). There was successful clearance (i.e. sufficient to view the tympanic membrane) in 91 per cent of cases. Patients who had used cerumenolytics reported significantly less pain and vertigo (p = 0.008 and p < 0.001, respectively) compared with those who had not, whilst patients with mastoid cavities reported greater levels of vertigo (p < 0.001) than those without.

Aural microsuction is well tolerated. Side effects are mild, and the prior use of cerumenolytics appears to further reduce their severity.

We report the case of an unusual late presentation of congenital tracheal stenosis in a 13-year-old boy. He was treated with minimally invasive Coblation resection of the stenotic segment, avoiding a major open tracheal resection and reconstruction. This case report is the first to document the use of an ultra-fine Coblation wand in the treatment of congenital tracheal stenosis.

The case proceeded well, without any complications. The patient had a fully healed and patent trachea at 12-week post-operative review.

Complex cases of congenital stenosis should be managed with a multidisciplinary approach. Different and novel treatment options should be explored to find one that suits the individual patient. Minimally invasive Coblation technology can offer less invasive treatment with quicker recovery and shorter hospitalisation.

Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.

The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.

A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.

Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.

This study aimed to present the histopathological and audiological effects of mechanical trauma associated with the placement of a model electrode in the scala tympani in rats, and the effects of continuous topical corticosteroid application.

The study comprised three groups of rats. The round window membrane was perforated in all three groups and a model electrode was inserted in the round window. Group one received no further treatments. Groups two and three also had an intrathecal microcatheter compatible with a mini-osmotic pump inserted; in group two this was used to release normal saline and in group three the pump released 400 µg/ml dexamethasone.

Dexamethasone infusion given after implantation of the intracochlear model electrode was more effective for preventing hearing loss than the administration of just one dose of dexamethasone.

The findings suggest that continuous dexamethasone infusion is beneficial for preventing the loss of hair cells and neurons associated with early and late periods of intracochlear electrode trauma.

New surgical techniques and devices have been described that decrease post-tonsillectomy morbidities. This study aimed to compare the two most popular tonsillectomy techniques.

Forty children underwent tonsillectomies using both the thermal welding and cold dissection techniques. In each patient, one side was removed with thermal welding and the other was removed with cold dissection.

There was a significant decrease in intra-operative blood loss, and the mean operation time was significantly lower on the thermal welding side compared with the cold dissection side. On the cold dissection side, tissue healing (i.e. the rate of complete tissue healing) was better and less pain was reported compared with the thermal welding side. However, there were no significant differences between the two techniques in terms of throat pain scores on the 1st, 3rd or 14th day post-operatively, or tissue healing scores on any of the post-operative days assessed.

Cold dissection resulted in better tissue healing and lower pain scores than thermal welding, but thermal welding was associated with less intra-operative blood loss and lower mean operation time than cold dissection.